21Sankarlingam Etal

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Sankarlingam et al., Int J Med Res Health Sci. 2015;4(1):130-134

International Journal of Medical Research

&

Health Scienceswww.ijmrhs.com Volume 4 Issue 1 Coden: IJMRHS Copyright @2014 ISSN: 2319-5886

Received: 21st Oct 2014 Revised: 8th Dec 2014 Accepted: 24th Dec 2014

Research article

A SHORT TERM OUTCOME OF STANDARD CRUCIATE RETAINING ARTHROPLASTY IN

PRIMARY OSTEOARTHRITIS OF KNEE

*Sankarlingam P1, Raja Pandian R

2, Vijayaragavan N

3

1Professor & Head ,

2Final year postgraduate ,

3Asst. Professor of Department of Orthopaedics, Meenakshi Medical

College and Research Institute, Enathur, Kancheepuram, Tamil Nadu

*Corresponding author email: [email protected]

ABSTRACT

Total condylar prosthesis, which was developed in 1974, was subsequently modified to a posterior cruciate

substituting the posterior stabilized version in around 1978 for the purpose of improving stair climbing, better

range of knee motion, prevention of posterior subluxation and more conforming knee kinematics. But, this

prospective study was performed in our institute, to assess the clinical and functional outcomes of standard

cruciate retaining arthroplasty in primary osteoarthritis of knee. Methods: 29 patients who are diagnosed primary

osteoarthritis knee underwent Cruciate retaining knee arthroplasty and followed up for a period of 2-3 years.

Results: In our study patients were evaluated according to Knee society scoring system, which showed

preoperatively poor grade and post operatively showed 73% excellent, 17 % good and 10% fair results with no

poor results. Conclusion: We concluded from our study that cruciate retaining knee arthroplasty provides pain

relief, good range of motion, deformity correction, no instability and no other complications.

Keywords: Total knee arthroplasty, Cruciate retaining, Posterior cruciate ligament, Knee Society Scoring.

INTRODUCTION

Total knee arthroplasty (TKA) has provided pain

relief and improved knee function for a variety of

arthritic conditions with good long term results.1-12

However, one of the most commonly cited reasons

for retaining the PCL is to preserve femoral rollback,

which improves extensor efficiency by lengthening

the moment arm and improves the range of flexion by

minimizing the potential for impingement of the

femur on the tibial component.13-21

Physiologic rollback in the normal knee is a complex

combination of rolling, gliding and rotation of the

femoral condyles relative to the tibial plateau that

results in a net posterior movement of tibiofemoral

contact in flexion.14,15,17,22-24

Normal rollback is

dependent on the integrity of the cruciate ligaments,which form a four-bar planar linkage between the

femur and tibia that constrains the relative

movements of the articular surfaces.23-25

During TKA,

the ACL is resected and the complex complementary

geometry of the articular surfaces is altered.

Therefore, the normal interaction of the four-bar

linkage mechanism and the articular surface is lost

and rollback cannot occur. However, under these

circumstances, if appropriately tensioned , the retained

PCL can exert a beneficial checkrein effect to

counteract the naturally occurring shear forces which

would otherwise result in anterior translation of the

femur on the tibia in flexion.26

This prospective study

was performed to assess the clinical and functional

outcomes of Cruciate retaining TKA.

MATERIALS AND METHODSThis study was started after the approval of Ethics

Committee of Meenakshi Medical College Hospital

DOI: 10.5958/2319-5886.2015.00021.1



Sankarlingam et al.,

And Research Institute. The p

conducted on 29 patients with

Tricompartmental OA knees in th

Orthopedics at Meenakshi Medical

and Research Institute, Kanchipura

between 45-70 years presented

knees who are not relieved

management underwent Cruciate

during the period of June 2011 to

were 18 females and 11 male patien

pre operatively and post operativ

knee society scoring33

. There w

diabetic patients included in this stu

with primary osteoarthritis with join

were included in the surgery. Rhe

with severe ligament damage of

who are unfit for surgery were ex

study. Patients, prior to knee replac

clinically screened for active

obtaining informed consent from p

posted for surgery.

Surgical technique: Under strict a

Combined spinal and epidural anest

to all patients. Patient in supine post

and draped. All cases operated

tourniquet. Prophylactic intravenou

used in all patients. Through midli

medial parapatellar arthrotomy, all

exposed. PCL was retained a

tensioned by partially releasing

attachment especially anterolateral

were made perpendicular to mecha

point made in the distal femur, and

5degree/6degree valgus. Finishing c

size required. After trail reduction,

were checked and final component

Patients were operated by the saminstrumentation provided by th

(genesis II - Smith & Nephew, A

Gemini – Link). Since the tourniqu

majority of transfusions wer

intraoperatively one unit and withi

operatively one unit if required.

adverse reactions.

Postoperatively, all patients receive

On 2nd

post operative day, afte

resistive quadriceps exercises, anklerange of motion exercises and wei

done as tolerated. The patients wer

Int J Med Res Health Sc

rospective study

30 symptomatic

e Department of

College Hospital

m. Patients aged

ith symptomatic

by conservative

retaining TKA

June 2014. There

ts were evaluated

ly according to

re 14 Type II

dy. All the cases

space narrowing

umatoid arthritis

CL and patients

cluded from our

ement, should be

infection. After

tients, they were

eptic precaution,

hesia were given

ure, parts painted

without using a

antibiotics were

ne skin incision,

the knees were

d appropriately

from femoral

ibers. Tibial cuts

nical axis. Entry

istal cut made in

ts as per femoral

patellar tracking

were cemented.

e surgeon, using manufacturers

C – Biomet, &

et was not used,

e administered

in 48 hours post

There were no

anticoagulation.

r drain removal

pump exercises, ght bearing were

e called back for

review at 1st

month, 3rd

year (Short-term follow

taken after surgery was

degrees should be avoi

crossed legs and squattin

Fig 1.1: Intra op –

fixation (AGC-Biomet)

The knee society scorin

of preoperative and

radiological outcome at

aims to assess the effec

Cruciate retaining TKA,

functional outcome.

RESULTS

In our study, there were

out of which bilateral

same sitting. Maximum

with mean age 65.86 ye

surgery in the ratio of 3:

1hour 30 min (range 1

Average amount of

operatively was 220 ml

follow up duration was

score preoperatively was

month – 68, 3rd month -

2nd

year - 84. There wer

according to knee soci

normal or weak quad

deformities in all cases,

degrees (range 10-30 de

physiological valgus (2-

in 90% of cases (Fig.2.1

is considerably increase

of 60 degrees to a post o

at the end of two years. (

1.1

131

i. 2015;4(1):130-134

month 6th, 1

styear and 2

nd

up study). Precautions to be

eep knee bending after 110

ed. Sitting on floor with

g should be avoided.

CL retained 1.2:Prosthesis

33

was used for assessment

postoperative clinical and

each follow up. This study

tiveness and efficiency of a

and to evaluate clinical and

18 females and 11 males and

KA was done in 1 case at

belonged to 60 – 69 years

rs and females are more for

1. Mean operating time was

hr 10 min to 1hr 50 min).

blood in the drain post

(range 150-280 ml). Mean

2 yrs. Mean knee society

52 and postoperatively at 1st

4, 6th -78,1st year-81 and at

e over 90% excellent results

ty score33

in patients with

riceps. There was varus

with an average angle of 20

ree), which was corrected to

degree). This was achieved

3.2). Range of knee motion

from a preoperative mean

erative mean of 100 degrees

ig.4.1-4.2)

1.2



132


Fig 2.1: Pre Operative - Antero Posterior View Fig 2.2:

Lateral view

Fig 3.1: Post Operative – Antero posterior View 3.2:

Lateral view

Though diabetes mellitus increases the chances of

infection, but no complication occurred in our study.

During the 2 year period of follow up there was no

case of loosening of tibial or femoral component. All

cases were having poor grade preoperatively

according to knee society scoring system andpostoperatively, there were 22 excellent, 5 good and 3

fair results in our study. (Fig.5)

Fig.4.1 Post operative-Sitting 4.2: Standing

Fig.5 Results graded according to Knee society score33

(Y axis – mean knee society score)

DISCUSSION

Osteoarthritis causes a lot of physical and mental

trauma to the patient because of pain and deformity.

TKA has emerged as a boon for patients suffering

from osteoarthritis and other deformities of knee

when conservative treatments have failed. The

proponents of CR claim that it acts as a Biologic

stabilizer and is capable of absorbing the shearing

forces and reduces the stresses at the prosthesis-bone

interface5, 27-32

. Andriacchi et al27, 30

demonstrated that

patients who received TKA with PCL preservation

were better at stair climbing than those who sacrificed

PCL.

According to this study, we were able to achieve the

physiological valgus of 2-7 degrees in all the cases.

We never used tourniquet. No cases were observed

with tibial or femoral component loosening. In our

study the follow up was done at 1st

month, 3rd

month,

6th month, 1st year and 2nd year. The results were

73% excellent, 17% good, 10% fair and no poor

results at the end of two years and these results are

obtained not only due to surgical skills but also

because of better antibiotics, proper sterilized

environment, early ambulation and physiotherapy.

There were no major complications in our study.

Limitation of our study is short term follow up, where

long term study is required.

0

10

20

30

40

50

60

70

80

90Mean knee society score

4.14.2

3.23.1

2.22.1



133


CONCLUSION

This study concludes that Cruciate retaining knee

arthroplasty in primary Osteoarthritis showed good

outcomes, good pain relief, good deformity

correction, good range of motion and no major

complications.

ACKNOWLEDGEMENT: This publication is the

result of three years of work whereby I have been

accompanied and supported by many people. I take

this opportunity to express my gratitude to our

beloved Chancellor, Vice Chancellor, Dean, Vice

Principal, Postgraduate Director for their guidance

throughout this work. I would like to thank my

assistants and postgraduates for helping me

throughout this study period.

Conflict of interest: Nil.

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21Sankarlingam Etal